Endoscopic Endonasal Skull Base Surgery: Current State of the Art and Future Trends

Endoscopic endonasal skull base surgery (EESBS) is undergoing a remarkable evolution as in the last two decades it shifted from pituitary surgery to a myriad of approaches extending from the cribriform plate to C2 and laterally to the petrous apex and to the infratemporal fossa. The collaboration with ENT surgeons, technological advances in the field of instrumentation and endoscopic systems, a better comprehension of the skull base anatomy as seen from below and recent innovations in reconstruction techniques have led to obvious improvements in the management of cranial base lesions. EESBS is now becoming the goldstandard approach to the sellar, retrosellar and clival regions; however, its role in the management of anterior skull base tumors is still debated. Through their experience of more than 400 endoscopic endonasal skull base procedures, the authors expose their modus operandi and discuss the current controversies as well as future trends.